Pediatrician sitting next to new mother and her baby.

Pediatrics Supporting Parents

Enhancing standards of care in pediatric well-child visits

What We Work For

We are exploring ways pediatric primary care can unite doctor and family to collectively support a child’s healthy social and emotional development.

Studies on early brain science have underscored that early experiences, especially those in the first three years of life when babies’ brains are developing at incredible rates, have lifelong effects on health, education, social and emotional well-being, future relationships, personal behavior, earning potential, and more. In particular, research has shown that children’s social and emotional development (SED) is vital for school readiness and is a key building block for cognitive development and learning at very young ages. With over 90 percent of all young children receiving at least one well-child visit in 2017, pediatric well-child visits present a unique opportunity for supporting parents in nurturing their children’s social and emotional development and relational health. They are frequent in infancy and early childhood, and they provide the setting for parents and pediatric health professionals to establish long-term partnerships to help children thrive.

How We Do It

We are exploring the transformation possible in pediatric primary care to center and promotes the social and emotional well-being of young children, the parent-child relationship, and parent mental health. To encourage more research, investments, initiatives, and individual practice change to scale this vision, we are raising up knowledge to the field about the concrete opportunities for practice and systemic change and are identifying the barriers that exist that prevent or slow widespread adoption of change. Currently, we are providing technical assistance to states and counties to test and implement strategies to finance initiatives and innovations in pediatric primary care through Medicaid and CHIP for a wide-reaching population. We created a guide that outlines opportunities for state Title V MCH programs and Medicaid agencies to support social-emotional development through promotion, screening, and prevention efforts. Throughout our work, we have engaged with communities and families who have shared their successes and struggles in this space, and we want to ensure their voices are paramount in our work.

To learn about the promising practices that could transform pediatric well-visits and understand the barriers faced, CSSP conducted a PSP Program Analysis of 13 programs across the country that are implementing promising or innovative programs to promote social and emotional health of young children and their families. Our study identified three categories of actions: 1. nurture parents’ competence and confidence; 2. connect families to additional supports to promote healthy social and emotional development and address stressors; and 3. develop the care team and clinic infrastructure and described 14 concrete common practices that pediatric primary care providers can take to begin transforming care in their clinics.

 

In collaboration with Manatt Health, CSSP is exploring the possibilities within Medicaid to finance and support effective strategies to foster the social and emotional development of young children. Initial findings were described in the Medicaid Blueprint, which shared 5 strategies and accompanying tools that state Medicaid and CHIP agencies, managed care plans, pediatric care providers, and others can use to optimize the social and emotional development of young children through a high-performing approach to pediatric practice. The five strategies are:

  1. Cover and support a full range of screening, assessment, and treatment services for children and their parents.
  2. Leverage quality and performance improvement initiatives to spur changes in pediatric practice.
  3. Establish payment models that support and incentivize a focus on the social and emotional development of children, ideally as part of a high-performing pediatric medical home.
  4. Facilitate investment in team-based care and training on children’s social and emotional development.
  5. Leverage a CHIP Health Services Initiative to finance interventions aimed at supporting children’s social and emotional development.

Additionally, we are facilitating two PSP Medicaid Implementation Workgroups, one national and one California focused to test and implement strategies that leverage Medicaid financing to promote social and emotional health of young children.

Lastly, CSSP partnered with Johnson Group Consulting, Inc. to develop a Guide to Leveraging Opportunities Between Title V and Medicaid for Promoting Social-Emotional Development. The guide is designed to support state-level planning, action, and innovation aligned with the goals of the PSP initiative, using a framework that stretches from promotion to screening to prevention to early intervention and treatment. It describes opportunities for state Title V MCH programs, state Medicaid agencies, and for the two in partnership, based on analysis of existing state innovations, research on how to promote social-emotional development, and federal law.

 

In the PSP Program Analysis, the Center for the Study of Social Policy (CSSP) took a deeper look at what is currently being done and what may be possible in the pediatric well-child visit (ages 0 – 3) and the pediatric primary care setting to promote positive outcomes around social and emotional development, the parent-child relationship, and parents’ mental health as it is a critical mediator of the parent-child relationship. CSSP’s analysis offered an opportunity to identify similarities among programs (“common practices”) that might be of value in pediatric primary care settings that do not adopt a particular, branded program. After conducting site visits and/or deeply researching 13 programs, CSSP’s work culminated in the report Fostering Social and Emotional Health through Pediatric Primary Care: Common Threads to Transform Everyday Practice and Systems. This report synthesized 3 categories of action and 14 common practices that promote children’s social and emotional development within the pediatric primary care setting. The report also shared barriers to the implementation of the practices as well as  recommendations for systemic reform.

 

 

Resources:

As a principal source of health coverage for the nation’s children and a growing proportion of their parents, Medicaid has a strong role to play in financing efforts to promote social and emotional development as part of the pediatric well-child visit. With sustainable financing, such efforts are more likely to become routine, expected components of pediatric primary care. CSSP and Manatt developed a set of actionable strategies that can be used to leverage Medicaid to foster social and emotional development through pediatric primary care, laid out in Blueprint for Using Medicaid to Finance Changes in Pediatric Care.

  1. Cover and support a full range of screening, assessment, and treatment services for children and their parents.
  2. Leverage quality and performance improvement initiatives to spur changes in pediatric practice.
  3. Establish payment models that support and incentivize a focus on the social and emotional development of children, ideally as part of a high-performing pediatric medical home.
  4. Facilitate investment in team-based care and training on children’s social and emotional development.
  5. Leverage a CHIP Health Services Initiative to finance interventions aimed at supporting children’s social and emotional development.

Throughout the second phase of the Medicaid project, CSSP and Manatt is leading a Medicaid State Implementation Workgroup with 7 states, providing customized technical assistance to each state based on their priorities within the Blueprint and facilitates opportunities for cross-team sharing.

CSSP and Manatt are working to launch a California County Implementation Workgroup, which provides TA to 4 California counties, and will develop a California Specific resource that describes of opportunities within Medi-Cal.

Resources:

The Center for the Study of Social Policy (CSSP) and Johnson Group Consulting, Inc. were asked by the Pediatrics Supporting Parents (PSP) initiative to develop a Guide to Leveraging Opportunities Between Title V and Medicaid for Promoting Social-Emotional Development. The guide is designed to support state-level planning, action, and innovation aligned with the goals of the PSP initiative, using a framework that stretches from promotion to screening to prevention to early intervention and treatment. As the largest federal-state health programs serving young children, Medicaid and the Title V Maternal and Child Health (MCH) Services Block Grant present important opportunities to catalyze transformation in pediatric primary care. We cannot achieve health equity for children without strong performance by these programs. Every state has the potential to improve the finance and delivery of pediatric primary care to better support parents and improve social-emotional development in ways that have lifelong impact. The guide describes opportunities for state Title V MCH programs, state Medicaid agencies, and for the two in partnership, based on analysis of existing state innovations, research on how to promote social-emotional development, and federal law.

Resources:

Partners

Manatt Health. Manatt Health integrates legal and consulting expertise to better serve the complex needs of clients across the health care system. Combining legal excellence, firsthand experience in shaping public policy, sophisticated strategy insight, and deep analytic capabilities, Manatt Health provides uniquely valuable professional services to the full range of health industry players.

Family Voices. Family Voices, a national, family-led, non-profit organization, works to improve health care services and supports for children through effective partnerships with families and family-led organizations. Staff and network members, who are themselves families of children with special health care needs and disabilities (CYSHCN), bring the voices of families representing the cultural, linguistic, ethnic, and geographic diversity of the nation to influence decisions at all levels of health care.

Johnson Group Consulting, Inc. The mission of the Johnson Group is to provide services that facilitate health policy development to improve the lives of women, children, and families. Johnson Group founder and president, Kay Johnson, has been a leader in health policy for women, children, and families for 35 years. She has been active in Medicaid and children’s health policy at the federal and state levels since 1984 and has served as an advisor to more than 40 state health and/or Medicaid agencies

Funders

This work is a joint initiative across five early childhood funders: Einhorn Collaborative, J.B. and M.K. Pritzker Family Foundation, The David and Lucile Packard Foundation, W.K. Kellogg Foundation, Overdeck Family Foundation, and an anonymous individual contributor.